心理护理对银屑病患者心理状态的影响

目的探讨银屑病患者的心理特点及心理护理措施。方法采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和症状自评量表(SCL-90)对160例银屑病患者的心理状况进行调查评估,定时定期对患者进行心理干预。结果 56.25%银屑病患者有抑郁症状,28.75%有焦虑症状;经心理护理干预后,抑郁患者的比例降至15.63%,焦虑患者降至4.55%。结论有效的心理护理措施能够显著降低银屑病患者焦虑和抑郁的比例,有利于患者身心的恢复。     

女性性病患者的焦虑抑郁情绪及心理干预研究

目的：探讨女性性病患者焦虑、抑郁情绪的心理状况，并观察心理干预对治疗依从性的影响。方法：将214例确诊女性性病患者在明确诊断后实施治疗前予以焦虑自评量表（SAS）和抑郁自评量表（SDS）评定其焦虑抑郁情绪，评定结果与107名健康女性评定结果进行对比分析。同时将该214例确诊的女性性病患者随机分为两组：A组（心理干预组）、B组（非心理干预组），于治疗所患性病后第三周末进行患者的治疗依从性判定，比较治疗所患疾病过程中两组患者的治依从性。结果：女性性病患者焦虑发生率为84％，抑郁发生率为78％；焦虑自评量表和抑郁自评量表总分均显著高于对照组（P〈0.01）；心理干预组患者的治疗依从性明显高于非心理干预组。结论：女性性病患者存在明显的焦虑抑郁情绪，可能成为其求诊和持续接受治疗的障碍，心理干预可提高其治疗依从性。     

慢性前列腺炎伴性功能障碍的心理因素研究

目的：探讨慢性前列腺炎（CP）伴性功能障碍患者的心理因素与疾病的相互关系。方法：将264例慢性前列腺炎患者按照有无性功能障碍分为患者组和对照组,采用一般调查表调查两组患者的一般资料,并采用90项症状自评量表（SCL-90）、焦虑自评量表（SAS）和抑郁自评量表（SDS）分别对两组进行评定。结果：对照组与患者组的SCL-90各因子分、SDS总分和SAS总分进行比较,两组评分存在显著差异;人际关系敏感、抑郁、焦虑、SDS总分、SAS总分为慢性前列腺炎伴性功能障碍患者疾病严重程度的影响因素。结论：慢性前列腺炎伴性功能障碍的患者存在明显的心理问题,CP症状严重程度及性功能障碍与心理障碍的发生有显著的相关性,对慢性前列腺炎伴性功能障碍患者进行心理干预是十分必要的。     

142例银屑病患者的心理健康状况调查及心理护理要素分析

目的：对银屑病患者的心理健康状况进行调查,分析对患者的心理护理要素,有助于提高临床治疗效果,改善患者生活质量。方法：采用SCL-90症状自评量表,对142例银屑病患者进行问卷调查,并与正常人常模数据对照。结果：银屑病患者SCL-90量表总分、总均分、阳性项目数、躯体化、抑郁、焦虑、恐怖、精神病性等因子评分明显高于正常人常模数据（P〈0.05）。结论：银屑病患者存有广泛的心理健康问题,如恐怖、抑郁、焦虑等心理障碍,在治疗银屑病的同时,应针对患者的个体情况,对其心理障碍进行有效的心理干预。     

白癜风患者焦虑、抑郁情绪与皮损的相关性

我们对297例确诊的白癜风患者进行焦虑、抑郁测定，分析其与皮损分期、分型，皮损数量、面积间关系，并对白癜风患者ZUNG焦虑自评与Hamilton焦虑他评量表（HAMA）及ZUNG抑郁自评与Hamilton抑郁他评量表（HAMD）结果的一致性进行分析。     

银屑病患者心理健康水平的评估及心理治疗

近来研究发现影响银屑病病程的心理因素主要有抑郁、焦虑及恐怖等。我们采用临床症状自评量表(Symptom Checklist90,SCL-90)焦虑自评量表(SAS)和抑郁自评量表(SDS)对33例银屑病患者进行了心理状态的调查,并与常模及瘢痕疙瘩量表进行比较。资料和方法2006年1~12月我院皮肤科门诊银屑病住院患者。银屑病组33例,男15例,女18例,年龄25~35岁,病程6个月~15年,自述首次发病前有明显精神压力或精神创伤者10例,瘢痕疙瘩组32例,男16例,女16例,年龄22~35岁,平均24.8岁,病程4个月~20年,平均7.52年,经统计学处理两组性别、年龄构成上无显著性差异。…     

人工荨麻疹与精神抑郁及焦虑症状的相关性研究

目的：确定人工荨麻疹患者发病与精神抑郁症状及焦虑症状的相关性。方法：用抑郁自评量表(SDS) 与焦虑自评量表（SAS）对人工性荨麻疹组患者100例进行症状量化评分,计算抑郁症状及焦虑症状发生率,并与寻常疣患者组（多少人？及健康对照组（多少人?)的评分进行比较分析。结果：人工荨麻疹组中抑郁症状及焦虑症状发生率与标准分值均明显高于寻常疣组和健康对照组(P<0.01,0.05)。结论：人工荨麻疹的发病可能与精神抑郁症状及焦虑症状有关。     

循证护理在银屑病心理护理中的应用

目的探讨循证护理应用于银屑病患者心理护理中的有效性和科学性。方法对2011年4月一2012年3月入住我院皮肤科的银屑病患者57例,在入院时统一发放自评抑郁量表（SDS）和自评焦虑量表（SAS）进行问卷调查,对其抑郁焦虑状态进行评估;再以“抑郁焦虑”为题进行实证检索,检索出相关文章168篇,对收集的文献进行分析,获得相关实证,将所获得实证与患者需求相结合,提出并实施音乐疗法、认知疗法、健康教育、建立良好的护患关系、建立“银屑病病友之家”、鼓励家庭成员参与到患者的治疗护理中6项护理措施。在患者出院时再次采用SDS和SAS进行评估。结果入院时和出院时SDS、SAS比较差异有统计学意义（P〈0．01）。结论将循证护理应用于银屑病患者的心理护理中,有利于患者焦虑抑郁状态的显著改善。     

银屑病患者负性情绪与神经生长因子受体表达的相关性研究

目的 探讨负性情绪对银屑病患者病程影响的分子病理学基础.方法用免疫组化法(SABC法)检测银屑病患者皮损中神经生长因子(NGF)的2个受体p75和p140trkA表达情况,同时应用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者进行问卷测评,并进行相关性统计学处理.结果银屑病患者的负性情绪(焦虑与抑郁)程度与2个神经生长因子受体表达呈正相关.结论NGF及其受体是负性情绪影响银屑病患者病情活动程度的重要中介物质。     

他汀类药物与患者抑郁、焦虑情绪的关系研究

目的探讨他汀类药物对患者抑郁、焦虑情绪产生的影响。方法应用抑郁自评量表（SDS）和焦虑自评量表（SAS）对患者抑郁、焦虑情绪状态进行评分,采用t检验初步比较应用他汀类药物治疗组和未服药组之间量表评分的差异;然后对2组的有关因素采用t检验或χ^2检验进行比较;最后,采用多元线性回归进行影响因素的分析。结果服药组与未服药组比较,抑郁和焦虑量表评分均无差异。结论他汀类药物对患者抑郁和焦虑情绪无影响。     

Economic burden of comorbidities in patients with psoriasis is substantial

Background Psoriasis is frequently associated with comorbidities. Objective To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. Methods Patients continuously enrolled ≥ 6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999–2004). Comorbidities identified during the 6‐month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6‐month follow‐up period were compared for patients with ≥ 1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log‐link and gamma distributions or two‐part models. Models controlled for age, sex and psoriasis severity. Results A total of 114 512 patients were included; 51% had ≥ 1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI)) = 1.58 (1.51–1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI) = 2.27 (2.13–2.42)] and outpatient visits [IRR (95% CI) = 1.53 (1.52–1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P < 0.001) greater total costs. Conclusion Comorbidities present a significant economic burden in patients with psoriasis.     

系统性心理行为干预对银屑病患者影响的研究

目的探讨系统性心理行为干预对银屑病患者的影响。方法将90例银屑病患者随机分为研究组(60例)和对照组(30例)。对照组给予常规药物治疗和护理,研究组在此基础上进行系统性心理行为干预。两组患者分别于干预前、干预后6个月、12个月进行焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depressionscale,SDS)、皮肤病生命质量指数(dermatology life quality index,DLQI)、银屑病PASI(psoriasis area and severity index,PASI)评分法测评,分析比较两组疗效及干预后6个月、12个月有效率。结果两组有效率在干预后6个月和干预后12个月比较,差异均有显著意义(P<0.05)。研究组SAS、SDS和DLQI在干预前、干预后6个月和12个月比较,差异均有显著意义(P<0.05);研究组有效率在干预后6个月和干预后12个月比较,差异有显著意义(P<0.05)。对照组SAS、SDS和DLQI在干预前、干预后6个月和12个月比较,差异均无显著意义(P>0.05)。结论系统性心理行为干预能显著改善银屑病患者的抑郁、焦虑情绪,有利于皮损症状的改善,提高生活质量,减少复发率。     

Prevalence of myocardial infarction in patients with psoriasis in central China

Objective To explore whether the prevalence of myocardial infarction (MI) was higher in psoriatics than in patients without psoriasis, and whether major cardiovascular risk factors were associated with psoriasis in central China. Methods Data were collected at Medical Records Section of Affiliated Union Hospital, Tongji Hospital, Wuhan Iron and Steel Company General Hospital and No. 1 Hospital of Wuhan between 1999 and 2007. Patients with psoriasis were classified as severe if they ever received a systemic therapy. And patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, or smoking. Controls without psoriasis were randomly selected from the Physical Examination Centre in the Affiliated Union Hospital. Analysis was performed by using conditional logistic regression, and adjustments were made for age and sex. Results There were 45 MIs (2.96%) within the control population and 97 (6.00%) and 118 (8.01%) MIs within the mild and severe psoriasis groups, respectively. Respective odds ratio (OR) and 95% confidence interval (95% CI) of cardiovascular risk factors in those with mild psoriasis than controls were as follows: obesity (OR, 1.41; 95% CI, 1.08–1.85), diabetes (OR, 1.45; 95% CI, 1.11–1.91), hypertension (OR, 1.39; 95% CI, 1.04–1.85), hyperlipidemia (OR, 1.37; 95% CI, 1.06–1.78) and smoking (OR, 1.35; 95% CI, 1.01–1.80). Patients with severe psoriasis had higher adjusted odds of obesity (OR, 1.51; 95% CI, 1.15–1.98), diabetes (OR, 1.69; 95% CI, 1.32–2.17), hypertension (OR, 1.41; 95% CI, 1.06–1.88), hyperlipidemia (OR, 1.43; 95% CI, 1.11–1.84), and smoking (OR, 1.57; 95% CI, 1.20–2.05) than patients with mild psoriasis and controls. After adjusting for systemic therapies and cardiovascular risk factors (obesity, diabetes, hypertension, hyperlipidemia and smoking) in addition to age and sex, for patients with mild or severe psoriasis, the OR of having an MI was 1.72 (95% CI, 1.29–2.30) and 2.01 (95% CI, 1.45–2.79), respectively. Conclusions The prevalence of MI is higher in mild andsevere psoriasis than in patients without psoriasis in central China. In addition, MI and major cardiovascular risk factors (e.g. diabetes, hypertension, hyperlipidemia and smoking) are associated with psoriasis in central China.     

Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors,but not with cardiovascular events in a population‐based sample

Background Psoriasis may significantly reduce quality of life. Previous studies reported an association of psoriasis and cardiovascular risk factors and cardiovascular events. The extent to which psoriasis is associated with psychiatric morbidity and the role of psychiatric comorbidity as a potential confounder of the association between psoriasis and cardiovascular morbidity require further investigation. Objectives To study the association between psoriasis, psychiatric morbidity and cardiovascular morbidity. Methods Case–control study utilizing an interdisciplinary administrative outpatient database from Germany. Patients with confirmed diagnosis of prevalent psoriasis within the study period (2003–2004) (n = 3147, mean age 57 years) were individually matched for age and gender with 3147 controls without psoriasis. The relationship of psoriasis with psychiatric morbidities (depression, stress‐related disorders, behaviour disorders and schizophrenic disorders), cardiovascular risk factors (diabetes, hypertension, obesity and dyslipidaemia) and cardiovascular events [myocardial infarction (MI), stroke] was investigated using logistic and linear regression models. Results Crude analyses suggested an association of psoriasis with depression, stress‐related disorders, behaviour disorders and cardiovascular risk factors, but not with MI [odds ratio (OR) 1.14; 95% confidence interval (95% CI) 0.81–1.62] or stroke (OR 0.97; 95% CI 0.61–1.54). Multivariate models controlling for age, gender and consulting behaviour indicated that psoriasis is independently associated with depression (OR 1.49; 95% CI 1.20–1.86), stress‐related disorders (OR 1.41; 95% CI 1.22–1.62), behaviour disorders (OR 1.58; 95% CI 1.05–2.39), diabetes (OR 1.21 95% CI 1.04–1.40), hypertension (OR 1.34; 95% CI 1.18–1.51), dyslipidaemia (OR 1.29; 95% CI 1.07–1.55), and obesity (OR 1.63; 95% CI 1.39–1.90). For each psychiatric condition, the likelihood of being affected significantly increased with each physician visit due to psoriasis, suggesting that the risk of psychiatric comorbidity increases with the severity of psoriasis. Conclusion Psoriasis appears to be independently associated with major psychiatric disorders and with cardiovascular risk factors, but not with cardiovascular events.     

银屑病与心血管疾病

银屑病是一种自身免疫性慢性炎症性疾病.最近流行病学研究显示,银屑病患者较易伴发心血管疾病.银屑病和动脉粥样硬化具相同病理特征.都涉及T细胞、单核细胞、巨噬细胞,尤其是T细胞经内皮外渗.活化的炎性细胞和促炎性因子参与银屑病皮损和动脉粥样硬化斑块的形成.同时发现,银屑病患者的高血压、高血脂、糖尿病、肥胖发生率比普通人群高,有些治疗银屑病的药物增加了银屑病患者心血管疾病的危险性.     

Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipidemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.     

Abordaje integral de la comorbilidad del paciente con psoriasis

The relationship between psoriasis and associated diseases has drawn particular interest in recent years. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found. Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa.This clinical practice guideline on the management of comorbidity in psoriasis has been drawn up to help dermatologists to achieve an integrated approach to this inflammatory disease. The guide focuses primarily on the diseases most often found in patients with psoriasis, which include psoriatic arthritis, cardiovascular disease, nonalcoholic fatty liver disease, inflammatory bowel disease, lymphoma, skin cancer, anxiety, and depression. Cardiovascular disease is approached through the study of its major risk factors (obesity, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome). Other cardiovascular risk factors related to lifestyle, such as smoking and alcohol consumption, are also discussed.The overall aim of this guide is to provide the dermatologist with a precise, easyto-use tool for systematizing the diagnosis of comorbidity in these patients and to facilitate decisions regarding referral and treatment once associated diseases have been found. The specific objectives are as follows: a) to review the most common diseases associated with psoriasis, including the prevalence of each one and its importance to the dermatologist; b) to provide guidelines for the physical examination, diagnostic tests, and clinical criteria on which to base a preliminary diagnosis; c) to establish criteria for the appropriate referral of patients with suspected comorbidity; d) to provide information on how therapies for psoriasis may modify the course of associated diseases, and e) to provide information concerning treatments prescribed for associated diseases that may have an impact on the course of psoriasis.This guide has been written by a working group of guideline methodologists and clinical experts. The selection of the diseases included was based on a systematic review of the literature and a summary of available evidence; information on the prevalence of each comorbidity was also taken from the literature. The recommendations on diagnostic criteria are based on the main clinical practice guidelines for each of the diseases discussed and on the recommendations of the expert advisory group. The information regarding the repercussions of psoriasis treatments on comorbid diseases was obtained from the summary of product characteristics of each drug. The statements concerning the impact on psoriasis of the associated diseases and their treatment are based on the review of the literature.     

Komorbidität bei Psoriasis vulgaris

Psoriasis is a systemic chronic inflammatory disease associated with comorbidity. Many epidemiological studies have shown that psoriasis is associated with psoriatic arthritis as well as cardiovascular and metabolic diseases. Furthermore, obesity and psychological diseases such as depression and anxiety disorders are linked with psoriasis and play a central role in its management. The association of psoriasis and its comorbidity can be partly explained by genetic and pathophysiological mechanisms. Approximately 40 psoriasis susceptibility loci have been described with the majority linked to the innate and adaptive immune system. In some associated diseases, such as psoriatic arthritis, an overlap of their genetic susceptibility exists. Pathophysiologically the “psoriatic march” is a model that describes the development of metabolic and cardiovascular diseases due to the presence of underlying systemic inflammation. Dermatologists are the gatekeepers to treatment for patients with psoriasis. The early detection and the management of comorbidity is part of their responsibility. Concepts for the management of psoriasis and tools to screen for psoriatic comorbidity have been developed in order to support dermatologists in daily practice.     

Association between Psoriasis and Cardiovascular Risk Factors in Korean Patients

Background

Previous studies have shown a possible association between psoriasis and cardiovascular risk factors.

Objective

We wanted to study the association between psoriasis and cardiovascular risk factors, including metabolic syndrome.

Methods

We determined the relationship of psoriasis with the cardiovascular risk factors, metabolic syndrome and cardiovascular disease. For the proper level of low-density lipoprotein (LDL) cholesterol, we calculated the proportion of psoriasis patients who needed lifestyle changes or drug therapy.

Results

This study included 197 patients with psoriasis and 401 controls. We found a higher prevalence of metabolic syndrome (17.8%, p=0.021), cardiovascular disease (4.6%, p=0.044), hypertension (32.5%, p=0.000) and hyperlipidemia (22.3%, p=0.025) in patients with psoriasis, as compared with that of the controls. To maintain proper LDL levels, 25.3% of the psoriasis patients needed lifestyle changes and 11.7% needed drug therapy.

Conclusion

Our results demonstrate a possible association between psoriasis and cardiovascular diseases and their risk factors (metabolic syndrome, hypertension and hyperlipidemia) in Korean patients. We also demonstrated that a substantial portion of patients with psoriasis need lifestyle changes and drug therapy to prevent cardiovascular events. Further studies will be necessary to establish the association and causality between psoriasis and the cardiovascular risk factors.     

慢性荨麻疹与精神焦虑及抑郁症状相关性研究

目的 探讨慢性荨麻疹患者发病与精神焦虑和抑郁症状的相关性。方法 随机选择36例慢性荨麻疹患者为A组,26例皮肤浅部真菌感染患者为B组,健康体检者30例为C组对照。分别用焦虑自评量表(SAS)、汉米顿焦虑量表(HAMA)、抑郁自评量表(SDS)、汉米顿抑郁量表(HAMD)进行症状量化评分检查,将3组的量表得分进行分析比较。结果 根据评分,3组间SAS、HAMA、SDS、HAMD评分差异有显著性(P<0.01),且A组中SAS、HAMA、SDS、HAMD评分均高于C组,差异有显著性(P<0.01)。B组中SAS、HAMA、SDS、HAMD评分与C组相比,差异均无显著性(P>0.05)。3组间用HAMA、HAMD评分结果焦虑及抑郁症状高于分界值(HAMA>14分、HAMD>17分)的发生率差异具有显著性(P<0.01)。A组用HAMA评分焦虑症状高于分界值的发生率(25.0%)较C组(3.3%)高,且差异有显著性(P<0.05);A组用HAMD评分抑郁症状评分高于分界值的发生率(33.3%)较C组(6.7%)高,且差异有显著性(P<0.01);B组与C组用HAMA、HAMD评分焦虑及抑郁症状高于分界值的发生率差异无显著性(P>0.05)。结论 部分慢性荨麻疹患者的发病及迁延不愈可能与精神焦虑及抑郁症状有关。